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reset

The repeal part of their “repeal and replace” promise was easy; the House has voted dozens of times to repeal or defund all or some of the law since its passage in 2010. It’s the replace part that’s a challenge. Republicans are divided over whether they should commit to a specific plan before November — and precisely what policies a GOP health bill should include.

The whole process has been marred by repeated starts and a great big stop. In January, House Majority Leader Eric Cantor promised his colleagues that they would get a vote on a plan. Throughout the spring, members maintained they were making strides toward consensus. But no agreement was reached.

Then came Cantor’s shocking primary defeat, forcing a House leadership reset. Rep. Steve Scalise (R-La.), a key sponsor of a conservative health bill that uses a free-market approach to health reform, will become majority whip later this month.

House Republicans agree that Scalise’s elevation is good news for ultimately getting a replacement measure to the floor, as a majority of them support the blueprint he and Rep. Phil Roe (R-Tenn.) rolled out last fall. But while Scalise has been touting the bill — most recently on a trip to Tennessee last week — he hasn’t promised the rank and file it will get a vote. That decision would ultimately be up to House Speaker John Boehner (R-Ohio) and incoming Majority Leader Kevin McCarthy (R-Calif).

In fact, no one’s predicting when a floor vote might happen. GOP lawmakers remain far from unified when it comes to the nitty-gritty details of what reforms to present and how to frame them to voters. They agree on some of the broad policy ideas, like allowing insurers to sell policies across state lines. But they don’t agree on how comprehensive reform should be, whether some tasks should be in state or federal hands, and what it should cost.

Roe thinks it’s time for Republicans to hammer out a plan, despite any political risks of giving Democrats new ammunition. “I am ready to debate the difference between the Affordable Care Act and what’s in our bill,” he said. “You can’t debate [ideas] unless you bring them before the committees and start talking about them.”

But finding a consensus bridge between far right and more establishment views is tricky for the GOP on health care. And about 40 percent of House Republicans have been elected since the ACA was passed. Many newer members ran on a promise to ditch Obamacare but aren’t as steeped in possible GOP alternatives.

“There just isn’t agreement, and I don’t think that agreement is going to be solved anytime soon,” said Avik Roy, a senior fellow at the conservative Manhattan Institute who writes frequently on health policy. “Expecting House Republicans to be the policy entrepreneurs in this case is not going to happen.”

It’s not that Republicans don’t have ideas to push. Some of the proposals have been around for years, or even decades — like letting insurers sell across state lines or letting small businesses pool to buy insurance. One of the most popular parts of Scalise and Roe’s blueprint would expand the ways health savings accounts can be used.

Each of those ideas would affect only individual parts of the health care system, however; they wouldn’t expand coverage to tens of millions of people, as the ACA is projected to do.